Healthy Relationships, Healthy Students, Healthy Lives

Dr. Jeff Temple brought the Fourth R program to Houston high schools as part of an effort to reduce and prevent dating violence through relationship-building skills.

Asset 11.png

By Ivy Ashe
Population Health Scholar
University of Texas System
PhD Student in Journalism
UT Austin Moody College of Communication


Reading, writing, arithmetic. They are the “Three Rs”—the basics of a child’s education.

Dr. Jeff Temple, Professor at The University of Texas Medical Branch in Galveston (UTMB), is working to add one more R—relationships—to the list.

Temple specializes in researching domestic violence, teen dating violence, substance abuse, and violence prevention and intervention. At the heart of his research is the idea that healthy relationships are the core of healthy living.

“Relationships are the foundation for everything,” he said. “That is really key in what I study.”

When he first started his research, Temple focused on domestic violence, specifically the consequences of victimization and the effectiveness of intervention programs. He also looked at the connection between substance abuse and domestic violence. The research was fruitful, showing that reductions in substance abuse aligned with fewer instances of domestic violence, but Temple wanted to move to a different model.

“I wanted to get away from consequences and intervening and move more towards prevention,” he said. “The idea was that if we can prevent dating violence in adolescents, we can prevent domestic violence in adults.”

Temple worked on an 8-year longitudinal study funded by the National Institutes of Health and the National Institute of Justice, which found that the patterns of dating violence—and in turn, domestic violence—start when people are quite young. The study found that if a person had not been in a violent relationship before 9th grade, there was only a small likelihood of being in a violent relationship over the next seven years.

For those who had been in violent relationships, about 50% were in a violent relationship several years later, relative to only about 10% of those not in a violence relationship early on. “It’s a big difference,” Temple said.

Yet adolescents learning to navigate their first relationships do so mainly by trial and error.

“I don’t think it has to be that way,” Temple said. “We don’t teach our kids algebra by trial and error. We teach them how to do it. We give them the skills, and the skills get more complicated.”

In 2015, Temple brought Fourth R, a relationship-building program that also targets multiple problem behaviors, to Texas. Created by Canadian researcher David Wolfe, the intent of the program is to provide teachers with a ready-made class curriculum that dovetails with topics typically addressed in health class. Since then, Fourth R has been implemented in high schools around the Houston area. A middle-school version is currently in the evaluation stage.

“We ask teachers to do a whole lot when, in addition to teaching, we also ask them to address how to avoid drugs and alcohol, to avoid risky sexual behavior, avoid bullying, avoid sexting, avoid violence, all of that,” Temple said. “We know that these one-off programs, like assemblies, they just don’t work. It’s a good effort, but it just doesn’t work.”

Fourth R encourages active participation in the curriculum through role-playing different relationship scenarios.

Teachers appreciate the ready-made lesson plans, he said, and both teachers and students alike appreciate the more dynamic Fourth R—even if that does take some getting used to. “It’s out of their comfort zone,” Temple said. “There are more giggles in the initial phases, but as we get moving they realize it’s kind of fun and they see it as a break from their academic day.”

Students might start with basic role-play, such as learning how to effectively apologize to someone. With those skills in hand, they can tackle more difficult relationship problems, like learning how to break up with someone.

“We practice,” Temple said. “Then, when they’re faced with these predicaments outside the classroom, they’ve already practiced and they’re going to be better at doing it.”

It’s a far cry from students learning about relationships from watching their friends (“They don’t have any good experience, either,” Temple said) or from the media, which glamorizes relationship violence.

“Even female to male violence is glamorized,” Temple said, citing Everyone Loves Raymond. “Ray’s wife would slap him for humor.”

Parents can be good resources when it comes to relationships, but even the most well intentioned parents make missteps. “They might get in an argument in front of their kids, but then they make up elsewhere, so the kids don’t get to witness how they resolve that conflict,” Temple said.

Fourth R is intended to help all students, not just those who might be more vulnerable to dating violence.

“The idea is rather than just trying to prevent violence, let’s try to promote healthy behaviors,” Temple said. “I think we have made a mistake in the past of using a deficit model, trying to fix what’s broken, as opposed to using a strengths-based model.”

Because the Fourth R curriculum was originally devised in Canada, some tweaks had to be made before it could be implemented in American schools. Hockey references were changed to football or baseball, for example. Students at Galveston’s Ball High School directed, produced, acted in, and filmed new video examples for the role-plays, so that the student body more closely resembled a Texas one. The Canadian curriculum included units on sexual identity and gender identity, but not all Texas schools used those.

Temple has discussed Fourth R in the context of school safety, speaking on a roundtable after the Santa Fe High school shooting in 2018. He testified before the state Senate and House of Representatives about reinstating health as a mandatory course in high schools. He and the Fourth R team are also working to make the curriculum fit with an online model, since many high schools now teach health online. They would like to make a more trauma-informed curriculum, one that also addresses topics like racism, discrimination, and homophobia.

“We know that so many kids have experienced adverse childhood experiences,” Temple said. “Fourth R does a decent job addressing that but I think we could do a better job.”

He is also collaborating with researcher Dr. Shannon Guillot-Wright, who created a healthy-relationships text messaging campaign. Students participating in the campaign get three text messages a week addressing relationship skills. “It’s not a big enough dose to have a huge impact but it’s something that can augment something like Fourth R and it reinforces the messaging,” Temple said. “We know that kids don’t read brochures, but they do read their texts.”